Cardiac Rhythm Management, A CardioSource Clinical Community

Trial Summary Minerva Randomized Study

Title: Atrial Antitachycardia Pacing and Managed Ventricular Pacing Reduce the Endpoint Composed by Death, Cardiovascular Hospitalizations, and Permanent Atrial Fibrillation
Year Presented: 2013
Topic(s): Arrhythmias, Cardiac Rhythm Management, Afib, Prevention/Vascular
Summary Posted: 11/18/2013
Writer: Anthony A. Bavry, M.D., M.P.H., F.A.C.C.
Author Disclosure:   CONSULTING FEES/HONORARIA: American College of Cardiology Cardiosource(SIGNIFICANT), Boehringer Ingelheim(MODEST) RESEARCH/RESEARCH GRANTS: Novartis Pharmaceuticals(MODEST), Gilead(SIGNIFICANT), Eli Lilly(MODEST)
Reviewer: Deepak L. Bhatt, M.D., M.P.H., F.A.C.C.
Reviewer Disclosure: CONSULTING FEES/HONORARIA: Elsevier Practice Update Cardiology(MODEST) RESEARCH/RESEARCH GRANTS: Astra Zeneca(SIGNIFICANT), Ethicon(SIGNIFICANT), Eisai(SIGNIFICANT), FlowCo(NONE), Amarin(SIGNIFICANT), Roche(SIGNIFICANT), Sanofi Aventis(SIGNIFICANT), PLx Pharma(NONE), Bristol Myers Squibb(SIGNIFICANT), The Medicines Company(SIGNIFICANT), Takeda(NONE), Medtronic(SIGNIFICANT) OTHER FINANCIAL BENEFIT: Belvoir Publications(SIGNIFICANT), Journal of Invasive Cardiology(SIGNIFICANT), Clinical Cardiology(NONE), WebMD(SIGNIFICANT), Slack Publications/Cardiology Research Foundation(SIGNIFICANT), Medscape Cardiology(NONE), Regado Biosciences(NONE)


The goal of the trial was to evaluate atrial anti-tachycardia pacing (DDDRP) and managed ventricular pacing (MVP) among patients with bradycardia and previous atrial tachyarrhythmia.


DDDRP and MVP will reduce atrial fibrillation occurrence and minimize right ventricular detrimental effects.

Drugs/Procedures Used:

Patients with bradycardia and previous atrial tachyarrhythmia who recently underwent permanent pacemaker placement were randomized to DDDR (n = 385), vs. DDDRP + MVP (n = 383), vs. MVP (n = 398).

Principal Findings:

Overall, 1,166 patients were randomized. The mean age was 74 years, and 50% were women.

The primary outcome occurred in 26.5% of the DDDR control group, 19.8% of the DDDRP + MVP group (p = 0.04 vs. control), and 21.4% of the MVP group (p = 0.12 vs. control).

DDDRP + MVP was associated with a reduction in permanent atrial fibrillation (hazard ratio = 0.39, p = 0.004).


Among patients with bradycardia and atrial tachyarrhythmia, the pacer mode DDDRP + MVP was superior at reducing composite cardiovascular outcomes compared with standard dual-chamber pacing. This was mainly due to prevention of permanent atrial fibrillation.

Study Design:

Randomized. Parallel.

Primary Endpoints:

  • Death, cardiovascular hospitalization, or permanent atrial fibrillation

Patient Population:

  • Patients with bradycardia and prior atrial tachyarrhythmia

    Number of enrollees: 1,166 patients
    Mean patient age: 74 years
    Percentage female: 50%


Presented by Dr. Giuseppe Boriani at the American Heart Association Scientific Sessions, Dallas, TX, November 18, 2013.